“The biggest problem for nurses is violence in the workplace, not physical violence but violence in our communications with doctors. There is so much unresolved conflict going on between us.”
(Registered Nurse who works in a San Francisco Bay Area Hospital)
There are many ways in which communication breakdowns can occur between nurses and doctors. One of the most common situations for such breakdowns is during hand-offs—when a doctor is passing a patient to a nurse. A good deal of important information can get missed or misinterpreted, due to unfounded assumptions they may have made about each other.
Unconscious Assumptions or Stereotypes
Research points out that we hold unconscious assumptions or stereotypes about people that have a direct influence on our behavior, says Dolly Chugh, a social psychologist and an associate professor at New York University’s Stern School of Business. We develop unconscious assumptions from the moment we were born and started to observe the settings around us. “Everything we take in—everything our parents tell us, everything we see on TV or hear in music, that we learn in school or from friends or see on the streets—all this adds up to associations in our brain,” Dr. Chugh says.
Societal expectations are a major factor in how healthcare professionals relate to other people on their team. Theresa Brown, a hospice nurse and author who writes frequently about patient care issues for the New York Times, says doctors have trained “as they’re the person who speaks. They have all the responsibility. The buck stops with them, but it also means they don’t really need to listen to the nurses,” in every instance. She says for the most part, nurses still “aren’t acculturated to speak up.”
A 2-Way Street
Brown says that although doctors often are rightfully blamed for communication issues or bad behavior, it’s a two-way street. “I don’t want to let nurses off the hook,” she says. “Sometimes you see nurses who bully doctors in training—the residents or interns—because they’ve had doctors beat up on them. “It’s this whole cycle that’s never going to stop.”
Jo-Ann Eastwood, associate professor in the advance practice program at the UCLA School of Nursing, says that variations in cultural approaches to communication and how different people approach authority figures in the hospital setting can also result in communication breakdowns.
How can nurses and doctors clear up miscommunications and resolve arguments they have about what is appropriate care for their patients?
Both doctors and nurses need to become increasingly aware of circumstances when they are racing up ladders of assumptions about each other’s judgments regarding what are correct medical diagnoses and treatments. Working together effectively as a team requires that they ultimately be willing to examine together particular assumptions each of them has made and revise them—or even abandon them completely—if they don’t pass the joint reality-checking process.
The Nurse's Ladder of Assumptions
THE SETTING. The nurses' station on the floor of the hospital where I work.
1-FACTS. At the end of my work shift, a hospitalist (a physician who cares solely for hospitalized patients) and I exchanged our respective views about the medical treatments that are the most appropriate for one of his patients to receive.
2-INTERPRETATIONS. The doctor is an arrogant, browbeating individual who is dismissive of my views, and disrespectful of my position as an experienced RN.
3-MOTIVES. The physician is trying to bully me into accepting his opinion as to the type of treatments his patient needs.
4-GENERALIZATIONS. He is one of those doctors who treat nurses as second-class citizens in the hierarchy of medical professionals.
5-ACTIONS. I boil over inside and stomp away from the doctor, angry that I wasn't heard.
Of course, the doctor will have his own ladder of assumptions. Examining how we race up the ladder helps us be accountable for our own behavior and listen for understanding to the individual with whom we have the conflict.